Common Problems When You Begin Breastfeeding

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The following problems are not uncommon during the get-acquainted phase of breastfeeding. Fortunately, such problems are usually worked out successfully before you leave the hospital or by the time your milk comes in abundantly. Don't be discouraged if things aren't picture-perfect; it's all part of the learning process. With patience and practice, both you and your baby will become more proficient in your roles. If you continue to have difficulty after you go home, you should seek expert help without delay. The sooner you detect a breastfeeding problem and get help, the easier it is to remedy.

Baby Won't Awaken to Nurse Some newborns sleep longer than desired in the early days of life, perhaps as a result of a long labor, medications used during childbirth, birth trauma, or other events. You might be anxious to begin breastfeeding, only to realize it takes two cooperative partners to make the process work. If more than about three and a half hours have passed without a feeding attempt, ask your baby's nurse to help you awaken your infant. Don't wait for your baby to cry to try to feed her. Instead, keep her with you in your room and try to arouse her from light sleep-look for eyelid movement, facial twitches, movements of her arms or legs, or mouthing motions. Unswaddle her from her blankets, change her diaper, remove some clothing, wipe her bottom with a wet washcloth, stroke her head, or massage her feet. Babies naturally open their eyes when placed upright. You can put her in a sitting position on your lap, with your hand supporting her chin, or hold her over your shoulder. Try dimming the lights if bright lights make her close her eyes.

Infant Has Difficulty Latching on to the Breast Even when the infant is awake, alert, and demanding, he may not latch on to your breast right away. Often the baby cries, acts distressed, and doesn't seem to know what to do. This can be enormously frustrating, especially when a mother has the misperception that breastfeeding should be as easy as falling off a log. It also can feel like outright rejection, and often a distraught mother will announce, "My baby doesn't want my breast." Nothing could be further from the truth. Of course your baby wants to breastfeed, but he doesn't yet know how to grasp your nipple/areola and obtain milk. If your baby is having trouble latching on, try the following measures:

Stop your efforts that have made you and the baby upset. Take a deep breath and calm down. Soothe your baby with your voice and by swaddling him. Try settling him down by letting him suck on your clean little finger inserted with the palm side (fleshy part) upward against the roof of his mouth. Tell yourself that latch-on difficulties are common and that many women have felt as you do right now. Keep your baby with you so you can try again as soon as he shows interest.

Help your baby enjoy being close to your breast. Keep him cradled at your breast even when you are not attempting to breastfeed. Remove your top and provide as much skin-to-skin contact as possible. These "breast-friendly" measures will help offset any frustration that either of you might experience from unsuccessful breastfeeding attempts.

Squeeze a few drops of colostrum onto your nipple to entice your baby or drip a little sugar water onto your nipple from a bottle.

Enlist a skilled nurse or hospital lactation consultant to help your baby attach correctly to your breast. Then you can apply the effective techniques she demonstrates when you are on your own.

Use a breast pump to express some milk. Offer this milk, or a small quantity of formula, preferably by cup or spoon, to calm your baby sufficiently to work with him at the breast again.

If your nipple is flat, use a pump for a few minutes to draw your nipple out and start some milk flowing before trying to attach your baby.

If your baby is using a pacifier, this could be reinforcing the expectation of a long, rigid nipple. Discontinue the pacifier until breastfeeding is going well.

As a last resort, start pumping your breasts approximately every three hours with a rental-grade electric pump to keep up your milk supply. Offer your expressed milk by bottle or other method to keep your baby well nourished. Continue to try to attach your baby at every available opportunity. As long as your baby remains well fed and your supply is maintained, your baby can eventually learn to breastfeed. Don't give up! You will need to arrange close follow-up with your baby's physician and a lacta-tion specialist after discharge.

Baby Won't Suck Some babies will initially attach to the nipple/areola, but then take only a few sucks before coming off the breast and crying. Usually these babies are frustrated at not receiving an immediate reward. Perhaps they have had one or more bottle-feedings and expect a rapid flow of milk as soon as a nipple enters their mouth. If an SNS device is available, it can be used to provide supplemental milk while the baby nurses, and thus keep the baby interested in breastfeeding. Usually, once the baby starts sucking rhythmically while using the SNS, the mother's own breast milk begins to flow. The device might be needed for only a feeding or two until the baby starts nursing effectively.

Another reason babies may not suck is that they may "shut down" when put to the breast. If previous attempts at feeding have been negative experiences, perhaps due to rough handling of the baby or aggressive efforts to push the nipple into his mouth, the baby may react to such distress by shutting down and refusing to feed. Other possible signals that your baby may be experiencing sensory overload and needs you to back off include hiccups, yawning, and the "stop sign," raising his hand with palm facing outward. Don't let any feeding session turn into a power struggle. Hold your baby tenderly, speak reassuringly, and let him rest securely against your breast. It might become necessary to pump and feed your expressed milk until feedings, in general, become a pleasant experience before resuming attempts at the breast. Since poor feeding can be a sign of infant illness, I must also caution that it's always essential for the hospital staff to evaluate a baby who isn't feeding well.

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